Medical Biller

Medical Biller - Full-Time

Department: Revenue Cycle / Billing
Employment Type: Full-Time
Reports To: Lead Biller / Operations Leadership
Company: Power Health Colorado (PHCO)
Position Summary

Power Health Colorado is seeking a full-time Medical Biller to join our Revenue Cycle team. This position is responsible for accurate and timely billing, payment posting, accounts receivable follow-up, denial management, and collection activities across a multidisciplinary medical practice.

PHCO treats patients across Workers' Compensation (WC), Personal Injury (PI), commercial insurance, and other applicable payer types. The ideal candidate is organized, accountable, detail-oriented, and comfortable working in a fast-paced environment where accurate billing and aggressive, appropriate follow-up directly impact the financial performance of the organization.

This is not simply a claim-entry position. The Medical Biller is expected to take ownership of assigned accounts from billing through resolution and collection.
Key Responsibilities
Billing & Claims

• Review charges and submit accurate claims in a timely manner.
• Verify CPT, ICD-10, modifiers, provider information, dates of service, and other claim information prior to submission.
• Identify missing or incomplete documentation that may delay billing or payment.
• Submit corrected claims, reconsiderations, and appeals when necessary.
• Maintain accurate billing notes and documentation within the practice management/EHR system.
• Work closely with providers, clinical staff, front office, and case management to resolve billing issues.

Accounts Receivable & Collections

• Actively work assigned A/R and follow up on outstanding balances.
• Identify unpaid, underpaid, denied, or incorrectly processed claims.
• Contact insurance carriers, adjusters, attorneys, funding companies, and other responsible parties as appropriate.
• Research payment discrepancies and pursue additional reimbursement when appropriate.
• Escalate aging or high-value accounts requiring additional intervention.
• Maintain clear documentation of all collection and follow-up activity.
• Work assigned accounts consistently until payment or appropriate resolution is obtained.

Workers' Compensation

• Understand and follow Colorado Workers' Compensation billing requirements and applicable fee schedules.
• Verify claim information, adjuster/carrier information, authorization status, and billing requirements.
• Assist with or submit Prior Authorization Requests (PARs) when required.
• Ensure supporting documentation, invoices, medical records, and other required materials are attached when necessary.
• Review WC payments for proper reimbursement and identify potential underpayments.
• Follow up directly with carriers and adjusters regarding unpaid or disputed balances.

Personal Injury

• Maintain accurate billing records for PI cases, including direct lien and other applicable arrangements.
• Coordinate with case management and attorneys regarding case status when necessary.
• Ensure bills and supporting documentation are available and submitted appropriately.
• Track outstanding PI balances and assist with settlement, reduction, or payment-related requests according to PHCO procedures.
• Maintain accurate financial information so leadership and case management have reliable visibility into outstanding balances.

Payment Posting & Reconciliation

• Accurately post insurance, patient, attorney, funding, and other payments.
• Apply contractual adjustments and other approved adjustments appropriately.
• Identify discrepancies between billed charges, expected reimbursement, and actual payment.
• Ensure payments are applied to the correct patient, claim, provider, and date of service.
• Assist with reconciliation and reporting as requested.

Denials & Appeals

• Review denials promptly and determine the root cause.
• Correct billing errors and resubmit claims when appropriate.
• Prepare appeals and provide supporting documentation.
• Track recurring denial trends and communicate systemic issues to leadership.
• Help identify opportunities to prevent future denials rather than repeatedly correcting the same issue.

Performance Expectations & KPIs

Performance will be evaluated using measurable Revenue Cycle outcomes, including:

• Clean Claim Rate: 95%+
• Timely Claim Submission: 95%+ of claims submitted within established PHCO standards
• Payment Posting Accuracy: 98%+
• Denial Follow-Up: Initial action within 5 business days
• A/R Follow-Up: Assigned accounts worked according to established aging and priority standards
• A/R Aging: Consistent reduction of balances greater than 60 and 90 days
• Underpayment Identification: Timely identification and follow-up of reimbursement discrepancies
• Documentation: 100% of collection and follow-up activity appropriately documented
• Productivity: Completion of assigned billing and A/R workload within established departmental expectations

The expectation is not simply to "touch" accounts. Accounts should move toward resolution and collection.
Qualifications
Required

• Previous medical billing, revenue cycle, or healthcare A/R experience.
• Working knowledge of CPT, ICD-10, modifiers, EOBs/ERAs, denials, and claim follow-up.
• Strong attention to detail and organizational skills.
• Ability to manage a high-volume workload and prioritize accounts appropriately.
• Strong written and verbal communication skills.
• Comfortable communicating with insurance carriers, adjusters, attorneys, patients, and internal staff.
• Ability to maintain patient confidentiality and comply with HIPAA requirements.

Preferred

• Experience with Workers' Compensation and/or Personal Injury billing.
• Knowledge of Colorado Workers' Compensation billing and fee schedules.
• Experience with PARs, appeals, and authorization requirements.
• Experience with eClinicalWorks (eCW) or similar EHR/practice management systems.
• Experience working within a multidisciplinary medical practice.
• Bilingual English/Spanish is a plus.

What We Are Looking For

We are looking for someone who takes ownership of their work. The right person does not wait for an aging report to become a problem before taking action.

Successful PHCO billers are:

• Accountable and dependable
• Highly organized
• Detail-oriented
• Persistent with follow-up
• Comfortable asking questions and identifying problems
• Able to work independently while remaining part of a team
• Focused on both accuracy and collections
• Interested in improving processes instead of simply maintaining them

About Power Health Colorado

Power Health Colorado is a multidisciplinary healthcare organization providing coordinated medical and rehabilitation services across multiple Colorado locations. Our teams work collaboratively across medical, rehabilitation, case management, and revenue cycle functions to provide high-quality care while maintaining strong operational and financial standards.

Power Health Colorado is an Equal Opportunity Employer.